1
|
Taclob JA, Kalas MA, McCallum RW. Examining linaclotide for the treatment of chronic idiopathic constipation. Expert Opin Pharmacother 2024; 25:1281-1290. [PMID: 39058326 DOI: 10.1080/14656566.2024.2386160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/18/2024] [Accepted: 07/25/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION Chronic idiopathic constipation (CIC) is characterized by infrequent bowel movements and hard stools lasting for at least three months or longer. This disease affects 8-12% of the US population and 10-17% of the world population. Treatment and management involve identifying the primary cause, changing dietary habits, and adequate physical activity. Linaclotide is a guanylate cyclase-agonist acting locally in the luminal surface of the intestinal enterocyte leading to a signal transduction cascade, activation of the cystic fibrosis transmembrane conductance regulator (CFTR), thus increasing secretion of chloride and bicarbonate into the intestinal lumen with eventual increased intestinal fluid and faster transit time. AREAS COVERED We reviewed multiple studies and did a thorough literature review on CIC including its pathophysiology. Through this literature review, we were able to discuss and give the context and rationale for drug regimens indicated for CIC. EXPERT OPINION The era we live in right now is akin to nutrient-rich and fertilized soil as knowledge and resources are abundant. The opportunities and potential are endless. Constipation being more extensively studied, our understanding of medications and diseases broadens, leading to novel medications being discovered. Linaclotide is a pioneer in this aspect and can pave the way for future generations.
Collapse
Affiliation(s)
- Jeff Angelo Taclob
- Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - M Ammar Kalas
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Richard W McCallum
- Division of Gastroenterology, Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| |
Collapse
|
2
|
Quitadamo P, Tambucci R, Mancini V, Campanozzi A, Caldaro T, Giorgio V, Pensabene L, Isoldi S, Mallardo S, Fusaro F, Staiano A, Salvatore S, Borrelli O. Diagnostic and therapeutic approach to children with chronic refractory constipation: Consensus report by the SIGENP motility working group. Dig Liver Dis 2024; 56:406-420. [PMID: 38104028 DOI: 10.1016/j.dld.2023.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 11/15/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023]
Abstract
Constipation is a common problem in children, accounting for about 3% of all primary care visits and up to 25% of referrals to paediatric gastroenterologists. Although polyethylene glycol often proves effective, most children require prolonged treatment and about 50% of them have at least one relapse within the first 5 years after initial recovery. When conventional treatment fails, children are considered to have refractory constipation. Children with refractory constipation deserve specialist management and guidance. Over the last decades, there has been a remarkable increase in our knowledge of normal and abnormal colonic and anorectal motility in children, and a number of different techniques to measure transit and motility have been developed. The present review analyses the possible diagnostic investigations for children with refractory constipation, focusing on their actual indications and their utility in clinical practice. Moreover, we have also analytically reviewed medical and surgical therapeutic options, which should be considered in selected patients in order to achieve the best clinical outcome.
Collapse
Affiliation(s)
- Paolo Quitadamo
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy.
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Mancini
- Department of Pediatrics and Neonatology, San Carlo Hospital, Milan, Italy
| | - Angelo Campanozzi
- Pediatrics, Department of Medical and Surgical Sciences, University of Foggia
| | - Tamara Caldaro
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentina Giorgio
- UOC Pediatria, Fondazione Policlinico Universitario A. Gemelli IRCSS, Roma, Italy
| | - Licia Pensabene
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Sara Isoldi
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy; Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Saverio Mallardo
- Maternal and Child Health Department, Sapienza - University of Rome, Santa Maria Goretti Hospital, Polo Pontino, Latina, Italy
| | - Fabio Fusaro
- Department of Medical and Surgical Neonatology, Newborn Surgery Unit, Digestive and Endoscopic Surgery, Gastroenterology and Nutrition, Intestinal Failure Rehabilitation Research Group, Bambino Gesù Children's Hospital Research Institute, Rome, Italy
| | - Annamaria Staiano
- Department of Translational Medical Science, Section of Pediatrics, University "Federico II", Naples, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale "F. Del Ponte", University of Insubria, Varese, Italy
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Paediatric Gastroenterology, UCL Institute of Child Health and Great Ormond Street Hospital, London, UK
| |
Collapse
|
3
|
Song G, Trujillo S, Fu Y, Shibi F, Chen J, Fass R. Transcutaneous electrical stimulation for gastrointestinal motility disorders. Neurogastroenterol Motil 2023; 35:e14618. [PMID: 37288650 DOI: 10.1111/nmo.14618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/17/2023] [Accepted: 05/05/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND/PURPOSE Gastrointestinal (GI) dysmotility is categorized by muscle or nerve dysfunctions in any portion of the GI tract, which leads to abnormalities in GI motor and sensory function. Symptoms may vary depending on the organ affected and can be debilitating. Treatment usually involves diet and lifestyle changes. Pharmacotherapy is limited in effectiveness with various side effects. Transcutaneous electrical stimulation (TES), a noninvasive, needleless technique that provides electrical stimulation using cutaneous non-needle electrodes, has become increasingly popular. It has been shown to be beneficial in treating GI motility disorders. METHODS This review paper navigates through the different TES techniques, including transcutaneous peripheral nerve (vagal/sacral/tibial nerves) electrical stimulation, transcutaneous electrical acustimulation (stimulation via acupuncture point), transcutaneous interferential current therapy, and transcutaneous electrical nerve stimulation. KEY RESULTS As we delve deeper, we explore the promising effects of TES on dysphagia, gastroesophageal reflux disease, functional dyspepsia, gastroparesis, postoperative ileus, constipation, and irritable bowel syndrome. The literature at hand speaks volumes about the therapeutic prowess of this noninvasive technique. CONCLUSION & INFERENCES The time is ripe to evaluate further the full therapeutic potential of TES, a noninvasive, nonpharmaceutical, nonsurgical, and home-based self-administrative technique in managing GI motility disorders.
Collapse
Affiliation(s)
- Gengqing Song
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sophie Trujillo
- Department of Internal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yuhan Fu
- Department of Internal Medicine, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fahmi Shibi
- Department of Gastroenterology and Hepatology, HaEmek Medical Center, Afula, Israel
| | - Jiande Chen
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ronnie Fass
- Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
4
|
Ferrari L, Cuinas K, Igbedioh C, Hainsworth A, Solanki D, Williams A, Sahai A, Kelleher C, Schizas A. Patient pathway in a tertiary referral pelvic floor unit: Telephone triage assessment clinic. Neurourol Urodyn 2023; 42:168-176. [PMID: 36317396 DOI: 10.1002/nau.25063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/31/2022] [Accepted: 10/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND To meet the increasing demands for colorectal pelvic floor services, a dedicated telephone triage assessment clinic (TTAC) was set up to establish a more efficient pathway, and reduce waiting times and patient's visits to the hospital. The primary aim of this study was to review TTAC in patients suffering from pelvic floor dysfunction and assess its feasibility. Secondary aims include measurement of waiting times for TTAC, main presenting complaints, and main treatment outcomes, including the need for review by a consultant surgeon. METHODS Review of data collected retrospectively in a single tertiary referral center collected from an institutional database. KEY RESULTS Between January 2016 and October 2017, 1192 patients referred to our pelvic floor unit were suitable for TTAC. Of these, 694 patients had complete records. There were 66 without follow-up after the initial TTAC, leaving 628 patients for analysis. In all, 86% were females and 14% were males, with a mean age of 52 years (range: 18-89). The median waiting time for TTAC was 31 days (range: 0-184). The main presenting complaint during the TTAC was obstructive defecation in 69.4%, fecal incontinence in 28.5%, and rectal prolapse in 2.1%. In our study, 611 patients had conservative management (97.3%), with a median of three sessions per patient (range: 1-16), while 82 patients (13.1%) needed a surgical intervention. Only 223 patients (35.5%) were reviewed by a consultant at some stage during the study period. CONCLUSIONS AND INFERENCES To optimize resources, an adequate triage system allowed us to streamline the pathway for each individual patient with pelvic floor dysfunction according to their symptoms and/or test results with the aim of reducing waiting times and expediting treatment.
Collapse
Affiliation(s)
- Linda Ferrari
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Karina Cuinas
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Carlene Igbedioh
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Alison Hainsworth
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Deepa Solanki
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Andrew Williams
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | - Arun Sahai
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| | | | - Alexis Schizas
- Pelvic Floor Unit, Guy's and St Thomas NHS foundation Trust, London, UK
| |
Collapse
|
5
|
Andresen V, Becker G, Frieling T, Goebel-Stengel M, Gundling F, Herold A, Karaus M, Keller J, Kim M, Klose P, Krammer H, Kreis ME, Kuhlbusch-Zicklam R, Langhorst J, Layer P, Lenzen-Großimlinghaus R, Madisch A, Mönnikes H, Müller-Lissner S, Rubin D, Schemann M, Schwille-Kiuntke J, Stengel A, Storr M, van der Voort I, Voderholzer W, Wedel T, Wirz S, Witzigmann H, Pehl C. Aktualisierte S2k-Leitlinie chronische Obstipation der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie & Motilität (DGNM) – April 2022 – AWMF-Registriernummer: 021–019. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:1528-1572. [PMID: 36223785 DOI: 10.1055/a-1880-1928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- V Andresen
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - G Becker
- Klinik für Palliativmedizin, Freiburg, Deutschland
| | - T Frieling
- Medizinische Klinik II, Helios-Klinikum Krefeld, Krefeld, Deutschland
| | | | - F Gundling
- Medizinische Klinik II (Gastroenterologie, Gastroenterologische Onkologie, Hepatologie, Diabetologie, Stoffwechsel, Infektiologie), Klinikum am Bruderwald, Bamberg, Deutschland
| | - A Herold
- Sozialstiftung Bamberg, End- und Dickdarm-Zentrum Mannheim, Mannheim, Deutschland
| | - M Karaus
- Abt. Innere Medizin, Evang. Krankenhaus Göttingen-Weende, Göttingen, Deutschland
| | - J Keller
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - M Kim
- Klinik und Poliklinik für Allgemein-, Viszeral-, Transplantations-, Gefäß- und Kinderchirurgie (Chirurgische Klinik I) des Universitätsklinikums, Zentrum Operative Medizin (ZOM), Würzburg, Deutschland
| | - P Klose
- Universität Duisburg-Essen, Medizinische Fakultät, Essen, Deutschland
| | - H Krammer
- Sozialstiftung Bamberg, End- und Dickdarm-Zentrum Mannheim, Mannheim, Deutschland
| | - M E Kreis
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland
| | | | - J Langhorst
- Knappschafts-Krankenhaus, Essen, Deutschland
| | - P Layer
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | | | - A Madisch
- Klinik für Gastroenterologie, interventionelle Endoskopie und Diabetologie, Klinikum Siloah-Oststadt-Heidehaus, Hannover, Deutschland
| | - H Mönnikes
- Klinik für Innere Medizin, Martin-Luther-Krankenhaus, Berlin, Deutschland
| | | | - D Rubin
- Klinik für Innere Medizin Schwerpunkt Gastroenterologie, DRK Kliniken Berlin Mitte, Berlin, Deutschland.,Klinik für Innere Medizin mit Schwerpunkt Gastroenterologie, Vivantes Klinikum Spandau, Spandau, Deutschland
| | - M Schemann
- Lehrstuhl für Humanbiologie, TU München, Freising, Deutschland
| | - J Schwille-Kiuntke
- Innere Medizin VI Psychosomat. Medizin u. Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Deutschland.,Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - A Stengel
- Medizinische Klinik mit Schwerpunkt Psychosomatik, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - M Storr
- Zentrum für Endoskopie, Starnberg, Deutschland
| | - I van der Voort
- Klinik für Innere Medizin Gastroenterologie und Diabetologie, Jüdisches Krankenhaus Berlin, Berlin, Deutschland
| | | | - T Wedel
- Anatomisches Institut, Universität Kiel, Kiel, Deutschland
| | - S Wirz
- Cura Krankenhaus Bad Honnef, Bad Honnef, Deutschland
| | - H Witzigmann
- Klinik für Allgemein- und Viszeralchirurgie, Krankenhaus Dresden-Friedrichstadt, Dresden, Deutschland
| | - C Pehl
- Medizinische Klinik, Krankenhaus Vilsbiburg, Vilsbiburg, Deutschland
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Colonic Function Investigations in Children: Review by the ESPGHAN Motility Working Group. J Pediatr Gastroenterol Nutr 2022; 74:681-692. [PMID: 35262513 DOI: 10.1097/mpg.0000000000003429] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Disorders of colonic motility, most often presenting as constipation, comprise one of the commonest causes of outpatient visits in pediatric gastroenterology. This review, discussed and created by the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Motility Working Group, is a practical guide, which highlights the recent advances in pediatric colonic motility testing including indications, technical principles of the tests, patient preparation, performance and basis of the results' analysis of the tests. classical methods, such as colonic transit time (cTT) with radiopaque markers and colonic scintigraphy, as well as manometry and novel techniques, such as wireless motility capsule and electromagnetic capsule tracking systems are discussed.
Collapse
|
7
|
Zhao Q, Chen YY, Xu DQ, Yue SJ, Fu RJ, Yang J, Xing LM, Tang YP. Action Mode of Gut Motility, Fluid and Electrolyte Transport in Chronic Constipation. Front Pharmacol 2021; 12:630249. [PMID: 34385914 PMCID: PMC8353128 DOI: 10.3389/fphar.2021.630249] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 06/28/2021] [Indexed: 12/12/2022] Open
Abstract
Chronic constipation is a common gastrointestinal disorder, with a worldwide incidence of 14–30%. It negatively affects quality of life and is associated with a considerable economic burden. As a disease with multiple etiologies and risk factors, it is important to understand the pathophysiology of chronic constipation. The purpose of this review is to discuss latest findings on the roles of gut motility, fluid, and electrolyte transport that contribute to chronic constipation, and the main drugs available for treating patients. We conducted searches on PubMed and Google Scholar up to 9 February 2021. MeSH keywords “constipation”, “gastrointestinal motility”, “peristalsis”, “electrolytes”, “fluid”, “aquaporins”, and “medicine” were included. The reference lists of searched articles were reviewed to identify further eligible articles. Studies focusing on opioid-induced constipation, evaluation, and clinic management of constipation were excluded. The occurrence of constipation is inherently connected to disorders of gut motility as well as fluid and electrolyte transport, which involve the nervous system, endocrine signaling, the gastrointestinal microbiota, ion channels, and aquaporins. The mechanisms of action and application of the main drugs are summarized; a better understanding of ion channels and aquaporins may be helpful for new drug development. This review aims to provide a scientific basis that can guide future research on the etiology and treatment of constipation.
Collapse
Affiliation(s)
- Qi Zhao
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research and Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Yan-Yan Chen
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research and Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Ding-Qiao Xu
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research and Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Shi-Jun Yue
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research and Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Rui-Jia Fu
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research and Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Jie Yang
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research and Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Li-Ming Xing
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research and Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Yu-Ping Tang
- Key Laboratory of Shaanxi Administration of Traditional Chinese Medicine for TCM Compatibility, and State Key Laboratory of Research and Development of Characteristic Qin Medicine Resources (Cultivation), and Shaanxi Key Laboratory of Chinese Medicine Fundamentals and New Drugs Research, Shaanxi University of Chinese Medicine, Xi'an, China
| |
Collapse
|
8
|
Kassab GS, Gregersen H, Sun D, Huang Z. Novel bionics developments in gastroenterology: fecobionics assessment of lower GI tract function. Physiol Meas 2021; 42. [PMID: 34190049 DOI: 10.1088/1361-6579/ac023c] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 05/17/2021] [Indexed: 11/12/2022]
Abstract
Biomechatronics (bionics) is an applied science that is interdisciplinary between biology and engineering (mechanical, electrical and electronics engineering). Biomechatronics covers a wide area and is probably best known in development of prosthetic limbs, vision aids, robotics and neuroscience. Although the gastrointestinal tract is difficult to study, it is particularly suited for a bionics approach as demonstrated by recent developments. Ingestible capsules that travel the tract and record physiological variables have been used in the clinic. Other examples include sacral nerve stimulators that seek to restore normal anorectal function. Recently, we developed a simulated stool termed fecobionics. It has the shape of normal stool and records a variety of parameters including pressures, bending (anorectal angle) and shape changes during colonic transit and defecation, i.e. it integrates several current tests. Fecobionics has been used to study defecation patterns in large animals as well as in humans (normal subjects and patient groups including patients with symptoms of obstructed defecation and fecal incontinence). Recently, it was applied in a canine colon model where it revealed patterns consistent with shallow waves originating from slow waves generated by the interstitial cells of Cajal. Furthermore, novel analysis such as the rear-front pressure (preload-afterload) diagram and quantification of defecation indices have been developed that enable mechanistic insight. This paper reviews the fecobionics technology and outlines perspectives for future applications.
Collapse
Affiliation(s)
- G S Kassab
- California Medical Innovations Institute, San Diego, CA, United States of America
| | - H Gregersen
- California Medical Innovations Institute, San Diego, CA, United States of America
| | - D Sun
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing, People's Republic of China
| | - Z Huang
- School of Microelectronics and Communication Engineering, Chongqing University, Chongqing, People's Republic of China
| |
Collapse
|
9
|
Abstract
Chronic constipation is one of the five most common symptoms seen by gastroenterologist. In the absence of alarm symptoms, a confident symptom-based diagnosis can often be made using the Rome criteria. Three different subtypes have been identified to date: normal transit constipation, defaecatory disorders and slow transit constipation. Differentiation between these subtypes can be made through functional testing using tests such as anorectal manometry with balloon expulsion and a radio-opaque marker test. In general, patients are initially advised to increase their fluid and fibre intake. When these general lifestyle recommendations do not improve patients' symptoms, a step-wise and add-on treatment approach should be applied. This review summarises the diagnostic criteria to differentiate functional constipation from other causes of chronic constipation. In addition, current drug treatment options, including discussion of new therapeutic targets are discussed. Further, practical treatment approaches (choice and dosing), include discussion of combination/augmentation, treatment failure (adherence/expectations), and relapse prevention are mentioned. Finally, treatment and management of pain and bloating aspects are included.
Collapse
Affiliation(s)
- Jasper Pannemans
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Herestraat 49, Box 701, 3000, Leuven, Belgium
| | - Imke Masuy
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Herestraat 49, Box 701, 3000, Leuven, Belgium
| | - Jan Tack
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Herestraat 49, Box 701, 3000, Leuven, Belgium.
| |
Collapse
|
10
|
Gregersen H. Novel Bionics Assessment of Anorectal Mechanosensory Physiology. Bioengineering (Basel) 2020; 7:E146. [PMID: 33202610 PMCID: PMC7712164 DOI: 10.3390/bioengineering7040146] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022] Open
Abstract
Biomechatronics (bionics) is an applied science that creates interdisciplinary bonds between biology and engineering. The lower gastrointestinal (GI) tract is difficult to study but has gained interest in recent decades from a bionics point of view. Ingestible capsules that record physiological variables during GI transit have been developed and used for detailed analysis of colon transit and motility. Recently, a simulated stool named Fecobionics was developed. It has the consistency and shape of normal stool. Fecobionics records a variety of parameters including pressures, bending, and shape changes. It has been used to study defecation patterns in large animals and humans, including patients with symptoms of obstructed defecation and fecal incontinence. Recently, it was applied in a canine colon model where it revealed patterns consistent with shallow waves originating from slow waves generated by the interstitial Cells of Cajal. Novel analysis such as the "rear-front" pressure diagram and quantification of defecation indices has been developed for Fecobionics. GI research has traditionally been based on experimental approaches. Mathematical modeling is a unique way to deal with the complexity. This paper describes the Fecobionics technology, related mechano-physiological modeling analyses, and outlines perspectives for future applications.
Collapse
Affiliation(s)
- Hans Gregersen
- The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China;
- California Medical Innovations Institute, San Diego, CA 92121, USA
| |
Collapse
|
11
|
Abstract
Motility of the gut is affected by the nervous system, the endocrine system, smooth muscle cells, interstitial cells of Cajal, secretory mucosal cells, the immune system, and gut flora. Abnormal gastrointestinal motility can generate nonspecific symptom complaints that are refractory to standard treatment approaches. It is important to exclude anatomical obstruction or other causes for patients' symptoms prior to proceeding with motility evaluation. Motility studies that help to evaluate children with suspected motility problems include combined multichannel intraluminal impedance (MII) and pH recording, esophageal manometry, gastric emptying scinitigraphy, antroduodenal manometry, colonic manometry, and anorectal manometry. Many pediatric gastrointestinal motility evaluations should be completed in a pediatric motility center where specialized training is completed by physicians in this field. Indications for pediatric gastrointestinal motility studies and how the procedures are performed are addressed in this paper.
Collapse
Affiliation(s)
- Jessica L Alexander
- Division of Pediatric Gastroenterology and Nutrition, Dayton Children's Hospital, Dayton, OH, United States
| | - Ramakrishna Mutyala
- Division of Pediatric Gastroenterology and Nutrition, Dayton Children's Hospital, Dayton, OH, United States; Department of Pediatrics, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States.
| |
Collapse
|
12
|
Gupta A, Basson S, Borrelli O, Lindley K, Thapar N, Saliakellis E, Curry J, Blackburn S. Surgically treated intractable constipation in children evaluated with colonic manometry. J Pediatr Surg 2020; 55:265-268. [PMID: 31757505 DOI: 10.1016/j.jpedsurg.2019.10.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 10/26/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND 'Intractable constipation' (IC) is constipation unresponsive to 3 months of optimal conventional treatment. Colonic manometry (CM) is recommended as a diagnostic modality for evaluation of these children. This study aimed to review outcomes of children with IC who were managed surgically at a single tertiary care center. METHODS Records of children with IC who were treated with ACE (antegrade colonic enema), colostomy, or ileostomy (2006-2018) were reviewed. "Success" was defined as adequate evacuation without need for further unplanned surgery. Data are median (range). RESULTS Sixty-seven children underwent surgery, of whom 56 with preoperative CM were included. Age at surgery was 8.6 (3.3-15.1) years. Eight had normal manometry and underwent ACE with 75% success. Thirty-six had left-sided dysfunction and underwent ACE (18), colostomy (14) or ileostomy (4) as initial intervention with 61, 70, and 100% success. Twelve with pancolonic dysfunction underwent ACE (6) or ileostomy (6) with 60 and 100% success. Twenty underwent repeat manometry 2.2 years (10 months-7.6 years) after surgery. Of 18 with stoma, 8 had resolution or improvement and of these, 7 underwent stoma reversal with a simultaneous ACE. Two patients with ACE had improvement, 1 is still on ACE washouts, and 1 is off all treatment. Ten with persistent dysfunction remain diverted. At 3.2 years (4 months-9.9 years) follow-up, 18 remain on ACE washouts, 9 have colostomy, 19 ileostomy, and 10 are off treatment and doing well. CONCLUSION We present a large series of patients who were surgically managed for IC. CM may guide therapy in these children. TYPE OF STUDY Retrospective comparative study LEVEL OF EVIDENCE: Level III.
Collapse
Affiliation(s)
- Alisha Gupta
- Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Sonia Basson
- Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, United Kingdom
| | - Keith Lindley
- Division of Neurogastroenterology and Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, United Kingdom
| | - Nikhil Thapar
- Division of Neurogastroenterology and Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, United Kingdom
| | - Efstratios Saliakellis
- Division of Neurogastroenterology and Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, United Kingdom
| | - Joseph Curry
- Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Simon Blackburn
- Department of Specialist Neonatal and Pediatric Surgery, Great Ormond Street Hospital, London, United Kingdom.
| |
Collapse
|
13
|
Mark EB, Poulsen JL, Haase AM, Espersen M, Gregersen T, Schlageter V, Scott SM, Krogh K, Drewes AM. Ambulatory assessment of colonic motility using the electromagnetic capsule tracking system. Neurogastroenterol Motil 2019; 31:e13451. [PMID: 30129117 DOI: 10.1111/nmo.13451] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/17/2018] [Accepted: 07/22/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND The Motilis 3D-Transit system tracks electromagnetic capsules as they traverse the gastrointestinal tract. The method is minimally invasive and ambulatory. Analysis has previously been limited to regional gut transit times, but new methods may allow detailed analysis of colonic motility. METHODS Parameters of colonic motility were analyzed from 34 3D-Transit recordings performed in healthy volunteers (median age 28 years; 8 F). Characteristic propulsive velocities and lengths of movement were determined to quantify common movement patterns. Data from seven patients with severe chronic diarrhea were included for comparison. KEY RESULTS Lack of capsule motion accounted for 82% (75%-87%) of total colonic transit time. Propulsive velocities were distributed with peaks at 0.5 cm/min (antegrade or retrograde) and 50 cm/min (antegrade). Based on velocity and length of propagation, five motor patterns were identified; (a) long fast antegrade, (b) fast antegrade, (c) slow antegrade, (d) slow retrograde, and (e) fast retrograde movements. Long fast antegrade movements were median 21 cm (10-96 cm). Capsule progression was faster during daytime than at night (5.9 cm/h vs 0.8 cm/h; P < 0.01). Colonic transit was faster in patients with chronic diarrhea than in healthy volunteers (5.4 h vs 18.2 h; P = 0.04), with higher capsule velocity (20.4 cm/h vs 4.4 cm/h; P < 0.01). CONCLUSIONS AND INFERENCES The 3D-Transit system now allows detailed description of colonic motility and our results are supported by those previously suggested by manometry. It holds promise for future assessment of movement patterns to characterize different diseases and effects of treatment.
Collapse
Affiliation(s)
- Esben Bolvig Mark
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jakob Lykke Poulsen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Anne-Mette Haase
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Marie Espersen
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark
| | - Tine Gregersen
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - S Mark Scott
- Neurogastroenterology Group (GI Physiology Unit), Queen Mary University, London, UK
| | - Klaus Krogh
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Mech-Sense, Department of Radiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
14
|
Kashihara Y, Terao Y, Yoda K, Hirota T, Kubota T, Kimura M, Matsuki S, Hirakawa M, Irie S, Ieiri I. Effects of magnesium oxide on pharmacokinetics of L-dopa/carbidopa and assessment of pharmacodynamic changes by a model-based simulation. Eur J Clin Pharmacol 2018; 75:351-361. [DOI: 10.1007/s00228-018-2568-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/27/2018] [Indexed: 10/28/2022]
|
15
|
Abstract
Constipation is one of the most common gastrointestinal symptoms in children. With a median reported prevalence of 12%, it accounts for about 25% of all pediatric gastroenterology consultations. The majority of children experiences functional constipation and do not usually require any diagnostic testing. For those children not responding to conventional medical treatment or in the presence of a more significant clinical picture, however, an accurate instrumental assessment is usually recommended to evaluate either the underlying pathophysiologic mechanisms or a possible organic etiology. The present review analyzes the possible diagnostic investigations for severely constipated children, focusing on their actual indications and their utility in clinical practice. During the last decade, there has been a remarkable increase in our knowledge of normal and abnormal colonic and anorectal motility in children, and a number of different techniques to measure transit and motility have been developed and are discussed in this narrative review.
Collapse
|
16
|
Kim SY, Woo HS, Kim KO, Choi SH, Kwon KA, Chung JW, Kim YJ, Kim JH, Kim SJ, Park DK. DA-9701 improves colonic transit time and symptoms in patients with functional constipation: A prospective study. J Gastroenterol Hepatol 2017; 32:1943-1948. [PMID: 28431454 DOI: 10.1111/jgh.13807] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/24/2017] [Accepted: 04/13/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM DA-9701, a newly developed prokinetic agent formulated with Pharbitis Semen and Corydalis Tuber, has been shown to effectively treat functional dyspepsia. Recently, it has also been suspected to improve gastrointestinal motor function. The aims of this study were to assess the effect of DA-9701 on colonic transit time (CTT) and symptoms of functional constipation. METHODS Thirty-three patients with functional constipation based on the Rome III criteria were prospectively enrolled. The patients received 30-mg DA-9701 three times a day for 24 days. CTT was estimated initially and at the end of treatment. Symptoms such as spontaneous bowel movements, straining, stool form, feeling of incomplete emptying and anorectal blockage, abdominal discomfort and pain, overall defecation satisfaction, and incidence of adverse events were also analyzed. RESULTS Twenty-seven patients completed the study. DA-9701 was associated with a significantly reduced CTT from 34.9 ± 17.6 to 23.7 ± 19.1 h (P = 0.001). Segmental CTT also significantly decreased after treatment (right CTT: from 16.8 [0.0-28.8] to 6.0 [0.0-25.2] hours, P < 0.001; rectosigmoid transit time: from 13.2 [0.0-38.4] to 6.0 [0.0-33.6] hours, P = 0.021). In addition, all constipation-related subjective symptoms, including spontaneous bowel movement frequency, significantly improved compared with those before treatment. Serious adverse events did not occur. CONCLUSIONS DA-9701 accelerates colonic transit and safely improves symptoms in patients with functional constipation. Therefore, we suggest that this novel agent could help to treat patients with this condition.
Collapse
Affiliation(s)
- Su Young Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| | - Hyun Sun Woo
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| | - Kyoung Oh Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| | - Sung Han Choi
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| | - Kwang An Kwon
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| | - Jun-Won Chung
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| | - Yoon Jae Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| | - Jung Ho Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| | - Su Ji Kim
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| | - Dong Kyun Park
- Division of Gastroenterology, Department of Internal Medicine, Gachon University, Incheon, South Korea
| |
Collapse
|
17
|
Dinning PG. Recording In Vivo Human Colonic Motility: What Have We Learnt Over the Past 100 Years? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 891:213-22. [PMID: 27379648 DOI: 10.1007/978-3-319-27592-5_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
To understand the abnormalities that underpin functional gut disorders we must first gain insight into the normal patterns of gut motility. While detailed information continually builds on the motor patterns (and mechanisms that control them) of the human esophagus and anorectum, our knowledge of normal and abnormal motility in the more inaccessible regions of the gut remains poor. This particularly true of the human colon. Investigation of in vivo colonic motor patterns is achieved through measures of transit (radiology, scintigraphy and, more recently, "smart pills") or by direct real-time recording of colonic contractility (intraluminal manometry). This short review will provide an overview of findings from the past and present and attempt to piece together the complex nature of colonic motor patterns. In doing so it will build a profile of human colonic motility and determine the likely mechanisms that control this motility.
Collapse
Affiliation(s)
- Phil G Dinning
- Department of Human Physiology, School of Medicine, Flinders University, Bedford Park, SA, 5042, Australia.
| |
Collapse
|
18
|
Norton C, Emmanuel A, Stevens N, Scott SM, Grossi U, Bannister S, Eldridge S, Mason JM, Knowles CH. Habit training versus habit training with direct visual biofeedback in adults with chronic constipation: study protocol for a randomised controlled trial. Trials 2017; 18:139. [PMID: 28340625 PMCID: PMC5366116 DOI: 10.1186/s13063-017-1880-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 03/08/2017] [Indexed: 02/08/2023] Open
Abstract
Background Constipation affects up to 20% of adults. Chronic constipation (CC) affects 1–2% of adults. Patient dissatisfaction is high; nearly 80% feel that laxative therapy is unsatisfactory and symptoms have significant impact on quality of life. There is uncertainty about the value of specialist investigations and whether equipment-intensive therapies using biofeedback confer additional benefit when compared with specialist conservative advice. Methods/design A three-arm, parallel-group, multicentre randomised controlled trial. Objectives: to determine whether standardised specialist-led habit training plus pelvic floor retraining using computerised biofeedback is more clinically effective than standardised specialist-led habit training alone; to determine whether outcomes are improved by stratification based on prior investigation of anorectal and colonic pathophysiology. Primary outcome measure is response to treatment, defined as a 0.4-point (10% of scale) or greater reduction in Patient Assessment of Constipation–Quality of Life (PAC-QOL) score 6 months after the end of treatment. Other outcomes up to 12 months include symptoms, quality of life, health economics, psychological health and qualitative experience. Hypotheses: (1) habit training (HT) with computer-assisted direct visual biofeedback (HTBF) results in an average reduction in PAC-QOL score of 0.4 points at 6 months compared to HT alone in unselected adults with CC, (2) stratification to either HT or HTBF informed by pathophysiological investigation (INVEST) results in an average 0.4-point reduction in PAC-QOL score at 6 months compared with treatment not directed by investigations (No-INVEST). Inclusion: chronic constipation in adults (aged 18–70 years) defined by self-reported symptom duration of more than 6 months; failure of previous laxatives or prokinetics and diet and lifestyle modifications. Consenting participants (n = 394) will be randomised to one of three arms in an allocation ratio of 3:3:2: [1] habit training, [2] habit training and biofeedback or [3] investigation-led allocation to one of these arms. Analysis will be on an intention-to-treat basis. Discussion This trial has the potential to answer some of the major outstanding questions in the management of chronic constipation, including whether costly invasive tests are warranted and whether computer-assisted direct visual biofeedback confers additional benefit to well-managed specialist advice alone. Trial registration International Standard Randomised Controlled Trial Number: ISRCTN11791740. Registered on 16 July 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1880-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | - Anton Emmanuel
- University College Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - Natasha Stevens
- Blizard Institute, Queen Mary University of London, 2 Newark Street, London, E1 2AT, UK
| | - S Mark Scott
- Blizard Institute, Queen Mary University of London, 2 Newark Street, London, E1 2AT, UK
| | - Ugo Grossi
- Blizard Institute, Queen Mary University of London, 2 Newark Street, London, E1 2AT, UK
| | - Sybil Bannister
- Blizard Institute, Queen Mary University of London, 2 Newark Street, London, E1 2AT, UK
| | - Sandra Eldridge
- Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - James M Mason
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Charles H Knowles
- Blizard Institute, Queen Mary University of London, 2 Newark Street, London, E1 2AT, UK
| |
Collapse
|
19
|
Borrelli O, Pescarin M, Saliakellis E, Tambucci R, Quitadamo P, Valitutti F, Rybak A, Lindley KJ, Thapar N. Sequential incremental doses of bisacodyl increase the diagnostic accuracy of colonic manometry. Neurogastroenterol Motil 2016; 28:1747-1755. [PMID: 27335210 DOI: 10.1111/nmo.12876] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 05/09/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Colonic manometry is the standard diagnostic modality for evaluating colonic motility in children. Intraluminal bisacodyl is routinely used to trigger high-amplitude propagating contractions (HAPCs), a feature of normal colonic motility. Usually, only a single dose (0.2 mg/kg) is suggested. We retrospectively explored whether the use of an additional higher (0.4 mg/kg) dose of bisacodyl increases the yield of colonic manometry. METHODS In 103 children (median age: 8.8 years, range 3.2-15.7 years) with a diagnosis of slow transit constipation, colonic motility was recorded for 1 h before and 1 h after each of two incremental doses of bisacodyl (low, L, dose: 0.2 mg/kg, max 10 mg; high, H, dose: 0.4 mg/kg, max 20 mg) and the characteristics of HAPCs analyzed. KEY RESULTS High-amplitude propagating contractions were seen in 85 children. H dose significantly increased the proportion of patients with fully propagated HAPCs (H dose: 57/103 [55%], L dose: 27/103 [26%], p < 0.001), paralleling the significant decrease in the proportion with partially propagated HAPCs (H dose: 29/103 [28%], L dose: 47/103 [46%], p < 0.01). Mean HAPC number significantly increased throughout the colon at H compared to L dose (7.2 ± 5.05 vs 5.6 ± 5.1, p < 0.05). Finally, the proportion of patients with normal pressure wave morphology of HAPCs significantly increased with higher dose (H dose: 55/85 [65%], L dose: 27/85 [32%], p < 0.001). CONCLUSIONS & INTERFERENCES An additional higher dose of bisacodyl during colonic manometry improves colonic neuromuscular function suggesting its use might improve interpretation and decision making in children with slow transit constipation.
Collapse
Affiliation(s)
- O Borrelli
- Division of Neurogastroenterology & Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK.
| | - M Pescarin
- Division of Neurogastroenterology & Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK
| | - E Saliakellis
- Division of Neurogastroenterology & Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK
| | - R Tambucci
- Division of Neurogastroenterology & Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK
| | - P Quitadamo
- Division of Neurogastroenterology & Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK
| | - F Valitutti
- Division of Neurogastroenterology & Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK
| | - A Rybak
- Division of Neurogastroenterology & Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK.,Department of Gastroenterology, Hepatology, Nutrition Disorders and Pediatrics, Children's Memorial Health Institute, Warsaw, Poland
| | - K J Lindley
- Division of Neurogastroenterology & Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK
| | - N Thapar
- Division of Neurogastroenterology & Motility, Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK.,Stem Cells and Regenerative Medicine, UCL Institute of Child Health, London, UK
| |
Collapse
|
20
|
Koppen IJN, Di Lorenzo C, Saps M, Dinning PG, Yacob D, Levitt MA, Benninga MA. Childhood constipation: finally something is moving! Expert Rev Gastroenterol Hepatol 2016; 10:141-55. [PMID: 26466201 DOI: 10.1586/17474124.2016.1098533] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Recent developments in the evaluation and treatment of childhood constipation are likely to influence the way we deal with pediatric defecation disorders in the near future. Innovations in both colonic and anorectal manometry are leading to novel insights into functional defecation disorders in children. Promising results have been achieved with innovative therapies such as electrical stimulation and new drugs with targets that differ from conventional pharmacological treatments. Also, new surgical approaches, guided by manometric findings, have led to improvement in patient outcome. Finally, utilization of non-pharmacological interventions such as fiber and probiotics has been a field of particular interest in recent years. The aim of this article is to provide an update on these and other novel diagnostic and therapeutic tools related to childhood constipation.
Collapse
Affiliation(s)
- Ilan J N Koppen
- a Department of Pediatric Gastroenterology and Nutrition , Emma Children's Hospital/Academic Medical Center , Amsterdam , The Netherlands.,b Division of Pediatric Gastroenterology, Hepatology, and Nutrition , Nationwide Children's Hospital , Columbus , OH , USA
| | - Carlo Di Lorenzo
- b Division of Pediatric Gastroenterology, Hepatology, and Nutrition , Nationwide Children's Hospital , Columbus , OH , USA
| | - Miguel Saps
- b Division of Pediatric Gastroenterology, Hepatology, and Nutrition , Nationwide Children's Hospital , Columbus , OH , USA
| | - Phil G Dinning
- c Departments of Gastroenterology & Surgery , Flinders Medical Centre, Flinders University , South Australia , Australia
| | - Desale Yacob
- b Division of Pediatric Gastroenterology, Hepatology, and Nutrition , Nationwide Children's Hospital , Columbus , OH , USA
| | - Marc A Levitt
- d Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Department of Surgery , The Ohio State University , Columbus , OH , USA
| | - Marc A Benninga
- a Department of Pediatric Gastroenterology and Nutrition , Emma Children's Hospital/Academic Medical Center , Amsterdam , The Netherlands
| |
Collapse
|
21
|
Miner PB, Camilleri M, Burton D, Achenbach H, Wan H, Dragone J, Mellgard B. Prucalopride induces high-amplitude propagating contractions in the colon of patients with chronic constipation: a randomized study. Neurogastroenterol Motil 2016; 28:1341-8. [PMID: 27270968 DOI: 10.1111/nmo.12832] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/07/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study compared prucalopride, a selective, prokinetic, 5-HT4 receptor agonist, with polyethylene glycol 3350 + electrolytes (PEG3350), an osmotic laxative, on colonic motility parameters, primarily high-amplitude propagating contractions (HAPCs) in patients with chronic constipation. METHODS This randomized, cross-over, reader-blinded study was conducted at a single site in the USA. The study was open to men and women aged 18-75 years who met study inclusion criteria. Colonic manometry catheters were inserted the day before investigation. On the investigation days, patients received oral 2 mg prucalopride or 2 × 13.8 g PEG3350 in solution. The primary endpoint was HAPC count (threshold: mean amplitude ≥100 mmHg, propagation ≥20 cm [HAPC1 ]) in the 12 h after treatment administration. Analyses were also conducted at two co-primary thresholds: mean amplitude ≥75 mmHg, propagation ≥20 cm (HAPC2 ); and mean amplitude ≥75 mmHg, propagation ≥10 cm (HAPC3 ). Secondary endpoints included HAPC area under the curve (AUC), contraction force, amplitude, duration, and propagation velocity. KEY RESULTS Thirteen women were enrolled, with 12 completing the study. Significantly more HAPC1 (8.7 ± 2.06 vs 2.9 ± 2.06; p = 0.012) and HAPC2 (9.0 ± 2.11 vs 3.3 ± 2.11; p = 0.017) were observed in the 12-h periods with prucalopride than with PEG3350. Prucalopride significantly increased mean propagation distance and velocity (HAPC2 ) and mean AUC, force, and amplitude (HAPC3 ) compared with PEG3350. Adverse events were mild or moderate. CONCLUSIONS & INFERENCES Prucalopride was superior to PEG3350 in inducing HAPCs in patients with chronic constipation. ClinicalTrials.gov number NCT01707667.
Collapse
Affiliation(s)
- P B Miner
- Oklahoma Foundation for Digestive Research, Oklahoma City, OK, USA
| | | | | | | | - H Wan
- Shire, Lexington, MA, USA
| | | | | |
Collapse
|
22
|
Rao SSC, Rattanakovit K, Patcharatrakul T. Diagnosis and management of chronic constipation in adults. Nat Rev Gastroenterol Hepatol 2016; 13:295-305. [PMID: 27033126 DOI: 10.1038/nrgastro.2016.53] [Citation(s) in RCA: 194] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Constipation is a heterogeneous, polysymptomatic, multifactorial disease. Acute or transient constipation can be due to changes in diet, travel or stress, and secondary constipation can result from drug treatment, neurological or metabolic conditions or, rarely, colon cancer. A diagnosis of primary chronic constipation is made after exclusion of secondary causes of constipation and encompasses several overlapping subtypes. Slow-transit constipation is characterized by prolonged colonic transit in the absence of pelvic floor dysfunction. This subtype of constipation can be identified using either the radio-opaque marker test or wireless motility capsule test, and is best treated with laxatives such as polyethylene glycol or newer agents such as linaclotide or lubiprostone. If unsuccessful, subspecialist referral should be considered. Dyssynergic defecation results from impaired coordination of rectoanal and pelvic floor muscles, and causes difficulty with defecation. The condition can be identified using anorectal manometry and balloon expulsion tests and is best managed with biofeedback therapy. Opioid-induced constipation is an emerging entity, and several drugs including naloxegol, methylnaltrexone and lubiprostone are approved for its treatment. In this Review, we provide an overview of the burden and pathophysiology of chronic constipation, as well as a detailed discussion of the available diagnostic tools and treatment options.
Collapse
Affiliation(s)
- Satish S C Rao
- Division of Gastroenterology and Hepatology, Augusta University, Medical College of Georgia, 1120 15th Street, AD 2226, Augusta, GA 30912, USA
| | - Kulthep Rattanakovit
- Division of Gastroenterology and Hepatology, Augusta University, Medical College of Georgia, 1120 15th Street, AD 2226, Augusta, GA 30912, USA
| | - Tanisa Patcharatrakul
- Division of Gastroenterology and Hepatology, Augusta University, Medical College of Georgia, 1120 15th Street, AD 2226, Augusta, GA 30912, USA
| |
Collapse
|
23
|
Daza W, Dadán S, Higuera M. Síntomas gastrointestinales en pediatría ¿conducen siempre al verdadero diagnóstico? REVISTA DE LA FACULTAD DE MEDICINA 2016. [DOI: 10.15446/revfacmed.v64n1.51379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p>Antecedentes. Los síntomas gastrointestinales son motivo frecuente de consulta pediátrica. Escasos estudios abordan la relación entre motivos de consulta (MC) y enfermedades gastrointestinales. Objetivos. Relacionar motivos de consulta con diagnósticos gastrointestinales definitivos (DGID) en pacientes pediátricos que acuden a una unidad de gastroenterología. Materiales y métodos. Estudio retrospectivo realizado entre enero del 2009 y diciembre del 2013. Se evaluó la relación entre los 10 principales MC con sus cinco primeros DGID bajo la prueba de ji cuadrado y la prueba exacta de Fisher. Resultados. Se reunieron 1171 pacientes. Los tres principales MC fueron dolor abdominal (DA) (12,3%), estreñimiento (12,1%) y reflujo gastroesofágico (8,4%). El Estreñimiento crónico funcional (ECF) (33,9%), la alergia alimentaria (AA), (17,3%) y la sospecha de AA (6,2%) constituyeron cerca del 50% de los DGID. El dolor abdominal, como motivo de consulta, se asoció con el diagnóstico de ECF, enfermedad ácido péptica (EAP) y AA; mientras que el estreñimiento como motivo de consulta se asoció con el diagnóstico de ECF, AA, sospecha AA e inercia colónica. Conclusión. El estreñimiento se ubica entre los primeros motivos de consulta y es el primer diagnóstico gastrointestinal directo con una asociación significativa entre ambos. Los profesionales de la salud deben estar atentos para detectar y diagnosticar esta entidad.</p>
Collapse
|
24
|
Abstract
Constipation, defined as delay or difficulty in defecation, present for 2 or more weeks, is a common problem encountered by both primary and specialty medical providers. There are no randomized controlled trials on the use of antegrade enemas in the pediatric population. Most published papers are based on the experience at a particular center. The aim of this article is to describe the pathophysiology of constipation, review the contribution of colonic manometry to the diagnosis of constipation, summarize the advancements in the management of constipation through the use of antegrade enemas, and study the outcomes of cecostomy at different centers. This study is a comprehensive literature review generated by computerized search of literature, supplemented by review of monographs and textbooks in pathology, gastroenterology, and surgery. Literature search was performed using the publications from 1997 to 2012. The search included publications of all types presenting or reviewing data on cecostomy. The antegrade continence enema is a therapeutic option for defecation disorders when maximal conventional therapy is not successful. Symptoms of defecation disorders in children with different underlying etiologies improve significantly after a cecostomy is created. In addition, there is a benefit on the patients' physical activity, healthcare utilization, and general well-being. Based on the review of published literature it seems that antegrade enemas are a successful therapeutic option in children with severe constipation and/or fecal incontinence. With the advent of cecostomy buttons, patient compliance and the overall cosmetic appearance have improved.
Collapse
|
25
|
Lu L, Yan G, Zhao K, Xu F. Analysis of the Chaotic Characteristics of Human Colonic Activities and Comparison of Healthy Participants to Costive Subjects. IEEE J Biomed Health Inform 2016; 20:231-9. [DOI: 10.1109/jbhi.2014.2371073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
26
|
Efficacy and Safety of Prucalopride in Chronic Constipation: An Integrated Analysis of Six Randomized, Controlled Clinical Trials. Dig Dis Sci 2016; 61:2357-2372. [PMID: 27056037 PMCID: PMC4943977 DOI: 10.1007/s10620-016-4147-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/25/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Prucalopride, a selective, high-affinity 5-hydroxytryptamine 4 receptor agonist, stimulates gastrointestinal and colonic motility and alleviates common symptoms of chronic constipation (CC) in adults. The relative efficacy by gender has not been evaluated. AIM To evaluate the global efficacy and safety of prucalopride 2 mg daily in men and women with CC using data from six large, randomized, controlled clinical trials. METHODS Data were combined from six phase 3 and 4, double-blind, randomized, placebo-controlled, parallel-group trials. The primary efficacy endpoint was the percentage of patients with a mean of ≥3 spontaneous complete bowel movements (SCBMs) per week over 12 weeks of treatment. Safety was assessed throughout all the trials. RESULTS Overall, 2484 patients (597 men; 1887 women; prucalopride, 1237; placebo, 1247) were included in the integrated efficacy analysis and 2552 patients were included in the integrated safety analysis. Significantly more patients achieved a mean of ≥3 SCBMs/week over the 12 weeks of treatment in the prucalopride group (27.8 %) than in the placebo group [13.2 %, OR 2.68 (95 % CI 2.16, 3.33), p < 0.001]. Prucalopride had a favorable safety and tolerability profile. Efficacy and safety outcomes were not significantly different between men and women. CONCLUSION The integrated analysis demonstrates the efficacy and safety of prucalopride in the treatment of CC in men and women.
Collapse
|
27
|
Dinning PG, Carrington EV, Scott SM. The use of colonic and anorectal high-resolution manometry and its place in clinical work and in research. Neurogastroenterol Motil 2015. [PMID: 26224550 DOI: 10.1111/nmo.12632] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In the esophagus, high-resolution manometry (HRM) has become a standard diagnostic tool in the investigation of suspected motility disorders. However, at the opposite end of the digestive tract (i.e., the colon and anorectum), the use of HRM still remains in its infancy, with relatively few published studies in the scientific literature. Further, the clinical utility of those studies that have been performed is largely undetermined. PURPOSE This review assesses all of the HRM studies published to date from both the colon and anorectum, explores the catheter types used, and attempts to determine the worth of HRM over traditional 'low-resolution' recordings from the same regions. Ultimately, this review addresses whether HRM currently provides information that will benefit patient diagnosis and treatment.
Collapse
Affiliation(s)
- P G Dinning
- Department of Surgery and Gastroenterology, Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
| | - E V Carrington
- National Centre for Bowel Research and Surgical Innovation and the GI Physiology Unit, Queen Mary University of London, London, UK
| | - S M Scott
- National Centre for Bowel Research and Surgical Innovation and the GI Physiology Unit, Queen Mary University of London, London, UK
| |
Collapse
|
28
|
Nimrouzi M, Zarshenas MM. Holistic Approach to Functional Constipation: Perspective of Traditional Persian Medicine. Chin J Integr Med 2015; 25:867-872. [PMID: 26597285 DOI: 10.1007/s11655-015-2302-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 12/17/2022]
Abstract
Traditional Persian medicine (TPM) proposes a different viewpoint to the chronic diseases. Diagnosis and implemented treatment are based on individual differences among patients. Constipation or Ea'teghal-e-batn is a condition in which the patient develops difficult or painful defecation. Based on TPM concepts, the fifirst digestion step starts from halq (oral cavity), and ends via defecation from the maq'ad (anus). Avicenna believed that four faculties, ha'zemeh (digestive), ja'zebeh (absorptive), ma'sekeh (retentive) and da'fe'eh (propulsive), are involved in the process of digestion and absorption of the ingested food and expelling the waste materials. The bowel movement and appearance of the stool is a measure for evaluating the gastrointestinal healthy function. Defecation should be with no pain and fecal material should have no burning and acuity. Low food intake or foods with dry temperament, dryness of gastrointestinal tract, diaphoresis and heavy exercise as well as intestine sensory loss were discussed as main causes of constipation. Management of constipation in TPM includes dietary schemes, oil massages and subsequently simple herbal medicines. According to TPM theories, the fifirst step in treating a disease is the elimination of disease causes (asbabe- maraz) and also providing the causes of health (asbab-e-sehhat). Health care providers should know the proper condition which the herbal medicines should be administered in and be able to guide the patients about the benefifits and hazards of herbal remedies, commonly used in their living origin.
Collapse
Affiliation(s)
- Majid Nimrouzi
- Essence of Parsiyan Wisdom Institute, Traditional Medicine and Medicinal Plant Incubator, Shiraz University of Medical Sciences, Shiraz, Iran.,Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad M Zarshenas
- Essence of Parsiyan Wisdom Institute, Traditional Medicine and Medicinal Plant Incubator, Shiraz University of Medical Sciences, Shiraz, Iran. .,Department of Traditional Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
29
|
Zhu X, Liu Z, Qu H, Niu W, Gao L, Wang Y, Zhang A, Bai L. The effect and mechanism of electroacupuncture at LI11 and ST37 on constipation in a rat model. Acupunct Med 2015; 34:194-200. [PMID: 26561562 PMCID: PMC4941155 DOI: 10.1136/acupmed-2015-010897] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2015] [Indexed: 01/03/2023]
Abstract
Background Electroacupuncture (EA) is used clinically for the treatment of constipation. Serotonin (5-hydroxytryptamine, 5-HT) plays an important role in colonic motility; however it is unknown whether alterations in colonic 5-HT are associated with EA. In this study, the effect and mechanism of EA at acupuncture points LI11 and ST37 were examined using a cold saline-induced rat model of constipation. Methods A rat constipation model was induced by cold saline gavage in 24 Sprague-Dawley rats. A further six rats were included as a Control group. The constipated rats were divided into four groups (n=6 each): a Constipation group that remained untreated; a Constipation+LI11 group that received EA at LI11; a Constipation+ST37 groups that received EA at ST37; and a Constipation+LI11+ST37 group that received EA at both LI11 and ST37. After EA treatment, faecal water content, defaecation frequency, and gastrointestinal (GI) transit were measured, as well as the expression of tryptophan hydroxylase (TPH) in colonic tissues (by Western blot analysis) and 5-HT in both faeces and colonic tissues (by ELISA). Results All three EA-treated groups demonstrated significant improvements in faecal water content, defaecation frequency and GI transit (p<0.05). In addition, TPH and 5-HT expression were both increased by EA at LI11 and/or ST37 (p<0.05). There were no significant differences between the three EA groups for any outcomes. Conclusions EA at LI11 and/or ST37 had a positive effect on objective markers of constipation in a rat model. In addition, EA increased 5-HT and TPH in the colonic tissues.
Collapse
Affiliation(s)
- Xianwei Zhu
- Innovation Research Centre of Acupuncture combined with Medicine, Shaanxi University of Chinese Medicine, Xi'an-Xianyang New Ecomic Zone, Shaanxi Province, China
| | - Zhibin Liu
- Innovation Research Centre of Acupuncture combined with Medicine, Shaanxi University of Chinese Medicine, Xi'an-Xianyang New Ecomic Zone, Shaanxi Province, China Department of Acupuncture and Moxibustion, Shaanxi University of Chinese Medicine, Xi'an-Xianyang New Ecomic Zone, Shaanxi Province, China
| | - Hongyan Qu
- Department of Acupuncture and Moxibustion, Shaanxi University of Chinese Medicine, Xi'an-Xianyang New Ecomic Zone, Shaanxi Province, China
| | - Wenmin Niu
- Innovation Research Centre of Acupuncture combined with Medicine, Shaanxi University of Chinese Medicine, Xi'an-Xianyang New Ecomic Zone, Shaanxi Province, China Department of Acupuncture and Moxibustion, Shaanxi University of Chinese Medicine, Xi'an-Xianyang New Ecomic Zone, Shaanxi Province, China
| | - Li Gao
- Department of Acupuncture and Moxibustion, Shaanxi University of Chinese Medicine, Xi'an-Xianyang New Ecomic Zone, Shaanxi Province, China
| | - Yuan Wang
- Innovation Research Centre of Acupuncture combined with Medicine, Shaanxi University of Chinese Medicine, Xi'an-Xianyang New Ecomic Zone, Shaanxi Province, China
| | - Aimin Zhang
- Department of Urologic Surgery, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xi'an-Xianyang New Ecomic Zone, Shaanxi Province, China
| | - Lu Bai
- Department of English, Shaanxi University of Chinese Medicine, Xi'an-Xianyang New Ecomic Zone, Shaanxi Province, China
| |
Collapse
|
30
|
A study of human colonic motility in healthy and constipated subjects using the wireless capsule. Comput Biol Med 2015; 65:269-78. [PMID: 26238703 DOI: 10.1016/j.compbiomed.2015.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 02/07/2023]
Abstract
Constipation is a common and distressing condition that has been linked to major morbidity, burdens the health care system, and impacts patients׳ quality of life. However, there is no perfect method for diagnosing and treating constipation. The purpose of this paper is to develop an automatic algorithm to identify patients with constipation from healthy subjects. Data from 12 healthy subjects and 10 patients with constipation were analyzed. The key challenges for data processing were data filtering, feature extraction, information evaluation, and providing the reference conclusion; these were resolved by employing the phase space reconstruction (PSR), independent component analysis (ICA), dynamic feature extraction algorithm, and the Wilcoxon rank sum test. The contractile frequency (Fr), motility index per unit time (MIU), average peak of peristaltic wave (Pave) and variance (Var) were extracted as dynamic parameters and analyzed. Results between groups were compared with the Wilcoxon rank sum test. There were statistically significant differences between healthy subjects and patients with constipation for Fr and MIU (P<0.05), whereas there was no statistically difference for Var. Moreover, the Fr and MIU of patients with normal transit constipation (NTC) are significantly lower compared to healthy subjects, whereas patients with slow transit constipation (STC) did not show significant differences. The proposed algorithms were able to differentiate between healthy subjects and patients with constipation based on the colonic motility profiles.
Collapse
|
31
|
Carmo RL, Oliveira RP, Ribeiro AE, Lima MC, Amorim BJ, Ribeiro AF, Ramos CD, Bustorff‐Silva JM, Lomazi EA. Colonic transit in children and adolescents with chronic constipation. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
32
|
Carmo RLML, Oliveira RPM, Ribeiro AEA, Lima MCL, Amorim BJ, Ribeiro AF, Ramos CD, Bustorff-Silva JM, Lomazi EA. Colonic transit in children and adolescents with chronic constipation. J Pediatr (Rio J) 2015; 91:386-91. [PMID: 25986613 DOI: 10.1016/j.jped.2014.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 10/17/2014] [Accepted: 10/22/2014] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess clinical features and colonic transit patterns in Brazilian children with refractory constipation. METHODS From 2010 to 2013, 79 constipated patients received follow-up care in a tertiary hospital. Of these patients, 28 (aged 8-14 years) were refractory to conventional therapy and underwent a simplified visual method of nuclear colonic transit study, by ingestion of a liquid meal containing 9.25 MBq/kg of (99m)Tc-phytate. Abdominal static images were taken immediately and at two, six, 24, 30, and 48h after ingestion for qualitative analysis of the radio marker progression through the colon. RESULTS Two patterns of colonic transit were found: slow colonic transit (SCT, n=14), when images at 48h showed a larger part of the tracer remained in proximal and transverse colon, and distal retention (DR, n=14), when after 30h, the radio isotope passed the transverse colon and was retained in the rectosigmoid up to 48h. The SCT and DR group included, respectively, nine and ten males; median ages in the nuclear study of 11 and 10 years, p=0.207; median duration of constipation of seven and six years, p=0.599. Constipation appearing during first year age (p=0.04) and report of soft stools (p=0.02) were more common in SCT patients. Palpable abdominal fecal impaction was found only in DR group. Appendicostomy for antegrade continence enema was successful in 4/12 (30%) of SCT patients (median follow-up: 2.4 years). CONCLUSION Nuclear transit study distinguished two colonic dysmotility patterns and was useful for guiding refractory patients to specific therapies.
Collapse
Affiliation(s)
- Rafael L M L Carmo
- School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Raquel P M Oliveira
- School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Antonio E A Ribeiro
- School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Mariana C L Lima
- Department of Radiology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Bárbara J Amorim
- Department of Radiology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Antonio Fernando Ribeiro
- Department of Pediatrics, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Celso D Ramos
- Department of Radiology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Joaquim M Bustorff-Silva
- Department of Surgery, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Elizete A Lomazi
- Department of Pediatrics, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
| |
Collapse
|
33
|
Xu F, Yan G, Zhao K, Lu L, Wang Z, Gao J. Quantifying the complexity of human colonic pressure signals using an entropy measure. BIOMED ENG-BIOMED TE 2015; 61:127-32. [PMID: 26043437 DOI: 10.1515/bmt-2015-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/17/2015] [Indexed: 11/15/2022]
Abstract
Studying the complexity of human colonic pressure signals is important in understanding this intricate, evolved, dynamic system. This article presents a method for quantifying the complexity of colonic pressure signals using an entropy measure. As a self-adaptive non-stationary signal analysis algorithm, empirical mode decomposition can decompose a complex pressure signal into a set of intrinsic mode functions (IMFs). Considering that IMF2, IMF3, and IMF4 represent crucial characteristics of colonic motility, a new signal was reconstructed with these three signals. Then, the time entropy (TE), power spectral entropy (PSE), and approximate entropy (AE) of the reconstructed signal were calculated. For subjects with constipation and healthy individuals, experimental results showed that the entropies of reconstructed signals between these two classes were distinguishable. Moreover, the TE, PSE, and AE can be extracted as features for further subject classification.
Collapse
|
34
|
Constipation enhances the propensity to seizure in pentylenetetrazole-induced seizure models of mice. Epilepsy Behav 2015; 44:200-6. [PMID: 25745976 DOI: 10.1016/j.yebeh.2015.01.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/24/2014] [Accepted: 01/10/2015] [Indexed: 11/22/2022]
Abstract
Epilepsy is characterized by spontaneous recurrent seizures and represents one of the most frequent neurological diseases, affecting about 60 million people worldwide. The cellular and neurocircuit bases of epilepsy are poorly understood. Constipation is a common gastrointestinal disorder characterized by symptoms such as straining, hard stool, and infrequent defecation. Population-based studies have shown that the prevalence of constipation is up to 30% of the population in developed countries. The causal link between seizure and constipation is a common belief among patients and physicians, but there are no scientific data to support this association. The current investigation evaluated the effects of constipation induced by loperamide (a peripheral μ-opioid receptor agonist without effect on central nervous system receptors) and clidinium (a quaternary amine antimuscarinic agent with reduced central nervous system effects) on two different seizure models of mice: (1) myoclonic, clonic, and generalized tonic seizures and death induced by intraperitoneal administration of pentylenetetrazole and (2) clonic seizure threshold induced by intravenous infusion of pentylenetetrazole. We demonstrated that the measured intestinal transit (%intestinal transit) decreased after loperamide or clidinium treatment for 3days. Constipation in mice which was induced by loperamide or clonidine caused a decrease in threshold to clonic seizure in the intravenous pentylenetetrazole seizure model. Moreover loperamide- or clidinium-induced constipation decreased latencies to, clonic, and tonic seizures and death in the intraperitoneal pentylenetetrazole model of mice. Serum ammonia levels were slightly elevated in both loperamide- and clidinium-treated mice. In conclusion, loperamide- or clidinium-induced constipated mice are more prone to seizure which might confirm the belief of patients and physicians about constipation as a trigger of seizure.
Collapse
|
35
|
Zhang XY, Xu H, Zheng Q, Zhang X. Expression of dopamine D2 receptor in the gastrointestinal mucosa of rats with slow transit constipation. Shijie Huaren Xiaohua Zazhi 2015; 23:93-98. [DOI: 10.11569/wcjd.v23.i1.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the expression of dopamine D2 receptor (Drd2) in the gastrointestinal mucosa of rats with slow transit constipation (STC) to explore the possible pathogenesis of STC.
METHODS: Twenty-four healthy Wistar rats were randomly into two groups: an experiment group and a control group. Rats of the experiment group were daily administered diphenoxylate (8 mg/kg) for 90 d to induce STC, while the control rats were fed normal saline. The number and weight of fecal granules and the body weight of rats were recorded every 5 d. After successful induction of STC, the rats were killed to take tissues of the gastric antrum, small intestine, and colon. Real-time polymerase chain reaction (RT-PCR) was used to detect the expression of Drd2 in the above tissues.
RESULTS: The daily number and mean weight of fecal granules and the time to discharge of the first black granule differed significantly between the two groups, suggesting that STC was successfully induced. Drd2 was specifically amplified by RT-PCR. Compared with the control group, the expression of Drd2 in the stomach and small intestine was not significantly different in the experiment group (P > 0.05 for both). However, the expression of Drd2 in colon tissues of STC rats was significantly higher than that in control rats (1.93 ± 0.78, P < 0.05).
CONCLUSION: The expression of Drd2 in the stomach and small intestine does not change significantly in STC rats, but Drd2 expression is up-regulated in colon tissues of STC rats, which may contribute to the pathogenesis of STC.
Collapse
|
36
|
Haase AM, Gregersen T, Schlageter V, Scott MS, Demierre M, Kucera P, Dahlerup JF, Krogh K. Pilot study trialling a new ambulatory method for the clinical assessment of regional gastrointestinal transit using multiple electromagnetic capsules. Neurogastroenterol Motil 2014; 26:1783-91. [PMID: 25348504 DOI: 10.1111/nmo.12461] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 09/24/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastrointestinal (GI) motor disorders often involve several regions of the GI tract. Therefore, easy and safe assessment of whole gut and regional motility is valuable for more precise diagnosis. 3D-Transit is a novel method for ambulatory evaluation of total and regional gastrointestinal transit times (GITT) based on the anatomical localization of ingestible electromagnetic capsules. The main purpose of this study was to test the performance of the 3D-Transit system. METHODS Twenty healthy volunteers each ingested three electromagnetic capsules over a period of two consecutive days. Standard radio-opaque markers (ROM) were also ingested to assess the agreement between total GITT obtained with both methods. KEY RESULTS Investigations were well-tolerated and three capsules could be tracked simultaneously with minimal data loss (Capsule 1: median: 0.2% of time (range 0-25.3%). Region specific contraction patterns were identified and used for computation of total and regional GITT in all subjects. Inter-observer agreement was 100% for total GITT (median variation 0%) but less for regional GITT. Day-to-day and diurnal variations were significant for total and regional GITT. Total GITT assessed by 3D-Transit capsules were moderately well-correlated to those assessed with standard ROM (Spearman's rho = 0.7). CONCLUSIONS & INFERENCES 3D-transit is a well-tolerated and minimal invasive ambulatory method for assessment of GI motility. By providing both total and regional transit times, the 3D-Transit system holds great promise for future clinical studies of GI function in health and disease.
Collapse
Affiliation(s)
- A M Haase
- Neurogastroenterology Unit, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Dalziel JE, Spencer NJ, Dunstan KE, Lynch AT, Haggarty NW, Gopal PK, Roy NC. An in vitro rat model of colonic motility to determine the effect of β-casomorphin-5 on propagating contractions. Food Funct 2014; 5:2768-74. [DOI: 10.1039/c4fo00193a] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Measurement of contractions that propagate along the length of the isolated large intestine as anin vitromodel for effects of food substances on gastro-intestinal transit.
Collapse
Affiliation(s)
- J. E. Dalziel
- Food Nutrition & Health Team
- Food & Bio-based Products Group
- AgResearch
- Grasslands Research Centre
- Palmerston North 4442, New Zealand
| | | | - K. E. Dunstan
- Food Nutrition & Health Team
- Food & Bio-based Products Group
- AgResearch
- Grasslands Research Centre
- Palmerston North 4442, New Zealand
| | - A. T. Lynch
- Food Nutrition & Health Team
- Food & Bio-based Products Group
- AgResearch
- Grasslands Research Centre
- Palmerston North 4442, New Zealand
| | - N. W. Haggarty
- Fonterra Co-operative Group
- Palmerston North, New Zealand
| | - P. K. Gopal
- Fonterra Co-operative Group
- Palmerston North, New Zealand
| | - N. C. Roy
- Food Nutrition & Health Team
- Food & Bio-based Products Group
- AgResearch
- Grasslands Research Centre
- Palmerston North 4442, New Zealand
| |
Collapse
|
38
|
High resolution colonic manometry--what have we learnt?--A review of the literature 2012. Curr Gastroenterol Rep 2013; 15:328. [PMID: 23709203 DOI: 10.1007/s11894-013-0328-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite its size and physiological importance, the human colon is one of the least understood organs of the body. Many disorders arise from suspected abnormalities in colonic contractions, yet, due largely to technical constraints, investigation of human colonic motor function still remains relatively primitive. Most measures of colonic motility focus upon the transit speed (radiology, scintigraphy and, more recently, "smart pills"); however, only colonic manometry can measure pressure/force from multiple regions within the colon in real time (Dinning and Scott (Curr Opin Pharmacol 11:624-629, 2011)). Based upon data from colonic manometry studies, a number of different colonic motor patterns have been distinguished: (1) antegrade high amplitude propagating sequences (contractions), (2) low amplitude propagating sequences, (3) non-propagating contractions, and (4) and rarely episodes of retrograde (oral) propagating pressure waves (Dining and Di Lorenzo (Best Pract Res Clin Gastrolenterol 25(1): 89-101, 2011)). Abnormalities in the characteristics of these motor patterns should help to characterize dysmotility in a patient populations, and in both adults and children colonic motor abnormalities have been identified with manometry studies (Rao et al. Am J Gastroenterol 99(12):2405-2416, (2004), Di Lorenzo et al. Gut. 34(1): 803-807, (1993)). Yet, despite more than two decades of such studies, the clinical utility of colonic manometry remains marginal with no specific manometric biomarkers of colonic dysfunction being established ([Camilleri et al. Neurogastroenterol Motil. 20(12): 1269-1282, 2008). This has been highlighted recently in a colonic manometry study by Singh et al. (2013), in which 41 % of 80 patients, with confirmed slow transit constipation, were reported to have normal motility. While this may suggest that no motor abnormalities exist in a proportion of such patients, the finding may also reflect technical constraints in our ability to detail colonic motility patterns.
Collapse
|
39
|
Dinning PG, Wiklendt L, Gibbins I, Patton V, Bampton P, Lubowski DZ, Cook IJ, Arkwright JW. Low-resolution colonic manometry leads to a gross misinterpretation of the frequency and polarity of propagating sequences: Initial results from fiber-optic high-resolution manometry studies. Neurogastroenterol Motil 2013; 25:e640-9. [PMID: 23773787 DOI: 10.1111/nmo.12170] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 05/16/2013] [Indexed: 01/30/2023]
Abstract
BACKGROUND High-resolution manometry catheters are now being used to record colonic motility. The aim of this study was to determine the influence of pressure sensor spacing on our ability to identify colonic propagating sequences (PS). METHODS Fiber-optic catheters containing 72-90 sensors spaced at 1 cm intervals were placed colonoscopically to the cecum in 11 patients with proven slow transit constipation, 11 patients with neurogenic fecal incontinence and nine healthy subjects. A 2 h section of trace from each subject was analyzed. Using the 1 cm spaced data as the gold standard, each data set was then sub-sampled, by dropping channels from the data set to simulate sensor spacing of 10, 7, 5, 3, and 2 cm. In blinded fashion, antegrade and retrograde PS were quantified at each test sensor spacing. The data were compared to the PSs identified in the corresponding gold standard data set. KEY RESULTS In all subject groups as sensor spacing increased; (i) the frequency of identified antegrade and retrograde PSs decreased (P < 0.0001); (ii) the ratio of antegrade to retrograde PSs increased (P < 0.0001); and (iii) the number of incorrectly labeled PSs increased (P < 0.003). CONCLUSIONS & INFERENCES Doubling the sensor spacing from 1 to 2 cm nearly halves the number of PSs detected. Tripling the sensor spacing from 1 to 3 cm resulted in a 30% chance of incorrectly labeling PSs. Closely spaced pressure recording sites (<2 cm) are mandatory to avoid gross misrepresentation of the frequency, morphology, and directionality of colonic propagating sequences.
Collapse
Affiliation(s)
- P G Dinning
- Departments of Gastroenterology & Surgery, Flinders Medical Centre, Flinders University, South Australia, Australia; School of Medicine, University of New South Wales, New South Wales, Australia
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Suo JY, Xu H, Bi SY, Zhang X, Zheng Q. Expression of 5-hydroxytryptamine 3 receptor in the gastrointestinal tract of rats with slow transit constipation. Shijie Huaren Xiaohua Zazhi 2013; 21:2815-2819. [DOI: 10.11569/wcjd.v21.i27.2815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the expression of 5-hydroxytryptamine 3 (5-HT3) receptor in the gastrointestinal of rats with slow transit constipation (STC), and to explore its role in the pathogenesis of STC.
METHODS: Twenty-four healthy Wistar rats were divided into either an experimental group or a control group. The experimental group was daily administered with diphenoxylate (8 mg/kg) for 90 days to induce STC, while the control group was fed equal volume of normal saline. The number and weight of fecal granules and the body weight of rats were recorded every 5 days. An activated charcoal suspension pushing test was performed one week after the administration of diphenoxylate to assess whether STC was successfully induced. RT-PCR was used to detect the expression of 5-HT3 receptor in the stomach, small intestine and colon of rats.
RESULTS: By comparing the number of fecal granule, the mean weight of each fecal granule and the discharge time of the first granule of black feces between the experimental group and control group, we could judge that STC was successfully induced. 5-HT3 receptor could be specifically amplified by RT-PCR. The expression of 5-HT3 receptor in the stomach, small intestine and colon was significantly lower in rats with STC than in control rats (all P < 0.05).
CONCLUSION: The expression of 5-HT3 receptor is decreased in the stomach, small intestine and colon of rats with STC, which may contribute to the pathogenesis of STC.
Collapse
|
41
|
Martellucci J, Valeri A. Colonic electrical stimulation for the treatment of slow-transit constipation: a preliminary pilot study. Surg Endosc 2013; 28:691-7. [PMID: 24048815 DOI: 10.1007/s00464-013-3192-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 08/12/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Electrical stimulation of the gastrointestinal tract is an attractive concept. In this article we report on a procedure for electrical colonic pacing due to intramuscular electrode placement for slow-transit constipation and some preliminary results. METHODS From January 2011 to December 2012, all consecutive patients affected by constipation and evaluated in our Pelvic Floor Center were prospectively assessed. Patients who underwent colonic electrical stimulation were evaluated for the present study. RESULTS In the study period, 256 patients were evaluated for constipation; 58% were identified as having obstructed defecation syndrome, 27.3% with irritable bowel syndrome or mixed forms, 4% with pelvic floor dyssynergia, and 10.5% (27 patients) as having slow-transit constipation. After failure of all the maximal conventional therapies, two patients, candidates for colectomy, agreed to undergo colonic electrical stimulation before a resective treatment. Both patients were females, aged 34 and 29 years, and were suffering from severe constipation since childhood. The follow-up was 19 and 6 months. The number of bowel movements per week increased from 0.3 to 3.5 in the first patient and from 0.5 to 2.5 in the second patient. Both patients no longer needed laxatives, enemas, or any other treatment. The hospital stay was 4 days, the mean operative time was 120 min, and no complications were reported. CONCLUSIONS Colonic pacing seems to be feasible and shows positive results. Further studies are required with a larger number of patients and a longer follow-up period to confirm the role of this promising treatment for slow-transit constipation.
Collapse
Affiliation(s)
- Jacopo Martellucci
- General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy,
| | | |
Collapse
|
42
|
Bassotti G, Villanacci V, Creƫoiu D, Creƫoiu SM, Becheanu G. Cellular and molecular basis of chronic constipation: Taking the functional/idiopathic label out. World J Gastroenterol 2013; 19:4099-4105. [PMID: 23864772 PMCID: PMC3710411 DOI: 10.3748/wjg.v19.i26.4099] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 04/22/2013] [Accepted: 05/19/2013] [Indexed: 02/06/2023] Open
Abstract
In recent years, the improvement of technology and the increase in knowledge have shifted several strongly held paradigms. This is particularly true in gastroenterology, and specifically in the field of the so-called “functional” or “idiopathic” disease, where conditions thought for decades to be based mainly on alterations of visceral perception or aberrant psychosomatic mechanisms have, in fact, be reconducted to an organic basis (or, at the very least, have shown one or more demonstrable abnormalities). This is particularly true, for instance, for irritable bowel syndrome, the prototype entity of “functional” gastrointestinal disorders, where low-grade inflammation of both mucosa and myenteric plexus has been repeatedly demonstrated. Thus, researchers have also investigated other functional/idiopathic gastrointestinal disorders, and found that some organic ground is present, such as abnormal neurotransmission and myenteric plexitis in esophageal achalasia and mucosal immune activation and mild eosinophilia in functional dyspepsia. Here we show evidence, based on our own and other authors’ work, that chronic constipation has several abnormalities reconductable to alterations in the enteric nervous system, abnormalities mainly characterized by a constant decrease of enteric glial cells and interstitial cells of Cajal (and, sometimes, of enteric neurons). Thus, we feel that (at least some forms of) chronic constipation should no more be considered as a functional/idiopathic gastrointestinal disorder, but instead as a true enteric neuropathic abnormality.
Collapse
|
43
|
Li MM, Ye BX, Lin L. Rationale for clinical use of wireless motility capsule. Shijie Huaren Xiaohua Zazhi 2013; 21:166-170. [DOI: 10.11569/wcjd.v21.i2.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The wireless motility capsule (WMC) is a recently developed technique for evaluating gastrointestinal motility. As the capsule moves through the gastrointestinal tract, it allows for real-time measurement of the pH, temperature and pressure of its surrounding environment to indirectly calculate gastric emptying time (GET), small bowel transit time (SBTT), colonic transit time (CTT) and whole gut transit time (WGTT). The WMC is especially suitable for patients suspected of dysmotility in more than one region in the gastrointestinal tract. The US FDA has approved the WMC for the evaluation of gastric emptying time in patients with suspected gastroparesis and colonic transit time in patients with suspected chronic constipation, and for the characterization of antral and duodenal pressure profiles. In addition, the WMC has been tested as an alternative to scintigraphy and radiopaque marker technology in several clinical trails. This review summarizes the rationale for clinical use of the WMC.
Collapse
|
44
|
Abstract
Human defecation involves integrated and coordinated sensorimotor functions, orchestrated by central, spinal, peripheral (somatic and visceral), and enteric neural activities, acting on a morphologically intact gastrointestinal tract (including the final common path, the pelvic floor, and anal sphincters). The multiple factors that ultimately result in defecation are best appreciated by describing four temporally and physiologically fairly distinct phases. This article details our current understanding of normal defecation, including recent advances, but importantly identifies those areas where knowledge or consensus is still lacking. Appreciation of normal physiology is central to directed treatment of constipation and also of fecal incontinence, which are prevalent in the general population and cause significant morbidity.
Collapse
Affiliation(s)
- Somnath Palit
- Academic Surgical Unit (GI Physiology Unit), Barts and the London School of Medicine and Dentistry, Blizard Institute, Queen Mary University, London, UK.
| | | | | |
Collapse
|
45
|
Kim ER, Rhee PL. How to interpret a functional or motility test - colon transit study. J Neurogastroenterol Motil 2012; 18:94-9. [PMID: 22323993 PMCID: PMC3271260 DOI: 10.5056/jnm.2012.18.1.94] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 12/30/2011] [Accepted: 12/30/2011] [Indexed: 12/20/2022] Open
Abstract
Measurement of colon transit time is the most basic and primary tool in evaluating disorders of colonic motility. In particular, it is helpful in pathologic diagnosis and for planning management in patients with constipation. Several techniques for measuring colon transit time currently exist. The standard measurement of colon transit time has been performed using radioopaque marker test. The radioopaque marker test is the most widely used method; it is simple to perform as well as being cost effective. But, this technique produces radiation exposure. Radionuclide scintigraphy and wireless motility capsules are other techniques used to measure colon transit time. In radionuclide scintigraphy, the transit of radioisotope is viewed by gamma camera; this approach has an advantage in that it uses minimal radiation and it allows a physiological assessment of gastrointestinal transit. Wireless motility capsules have been validated most recently, but this technique is not useful in Korea. This review presents the techniques used to measure colon transit time and the interpretations provided in different colon transit studies.
Collapse
Affiliation(s)
- Eun Ran Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | |
Collapse
|
46
|
Spencer NJ, Kyloh M, Wattchow DA, Thomas A, Sia TC, Brookes SJ, Nicholas SJ. Characterization of motor patterns in isolated human colon: are there differences in patients with slow-transit constipation? Am J Physiol Gastrointest Liver Physiol 2012; 302:G34-43. [PMID: 21960519 DOI: 10.1152/ajpgi.00319.2011] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The patterns of motor activity that exist in isolated full-length human colon have not been described. Our aim was to characterize the spontaneous motor patterns in isolated human colon and determine whether these patterns are different in whole colons obtained from patients with slow-transit constipation (STC). The entire colon (excluding the anus), was removed from patients with confirmed STC and mounted longitudinally in an organ bath ∼120 cm in length, containing oxygenated Krebs' solution at 36°C. Changes in circular muscle tension were recorded from multiple sites simultaneously along the length of colon, by use of isometric force transducers. Recordings from isolated colons from non-STC patients revealed cyclical colonic motor complexes (CMCs) in 11 of 17 colons, with a mean interval and half-duration of contractions of 4.0 ± 0.6 min and 51.5 ± 15 s, respectively. In the remaining six colons, spontaneous irregular phasic contractions occurred without CMCs. Interestingly, in STC patients robust CMCs were still recorded, although their CMC pacemaker frequencies were slower. Intraluminal balloon distension of the ascending or descending colon evoked an ascending excitatory reflex contraction, or evoked CMC, in 8 of 30 trials from non-STC (control) colons, but not from colons obtained from STC patients. In many control segments of descending colon, spontaneous CMCs consisted of simultaneous ascending excitatory and descending inhibitory phases. In summary, CMCs can be recorded from isolated human colon, in vitro, but their intrinsic pacemaker frequency is considerably faster in vitro compared with previous human recordings of CMCs in vivo. The observation that CMCs occur in whole colons removed from STC patients suggests that the intrinsic pacemaker mechanisms underlying their generation and propagation are preserved in vitro, despite impaired transit along these same regions in vivo.
Collapse
Affiliation(s)
- Nick J Spencer
- Dept. of Human Physiology, School of Medicine, Flinders Univ., South Australia, Australia.
| | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
PURPOSE OF REVIEW The major motor functions of the large bowel include storage, propulsion and defecation. New developments continue to expand our knowledge of this area and provide significant advances in the treatment of disorders of colorectal motility. RECENT FINDINGS This article reviews new techniques to study colon motility and transit in health and constipation, recent published data which support the efficacy of novel and established laxatives for both functional and opioid-induced constipation, the development of neuromodulatory techniques for severe constipation and new insights into the pathogenesis and treatment of levator syndrome. SUMMARY The articles referenced in this review inform the reader of new developments in understanding and treating disorders of colonic and anorectal motility and anticipate future advances.
Collapse
|
48
|
Dinning PG, Scott SM. Novel diagnostics and therapy of colonic motor disorders. Curr Opin Pharmacol 2011; 11:624-9. [DOI: 10.1016/j.coph.2011.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 10/04/2011] [Accepted: 10/04/2011] [Indexed: 12/18/2022]
|